A. Ubicación Política
4.3.4 Parámetros a evaluar
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Addressing Alcohol Consumption and Alcohol-Related Harms at the Local Level
Restricting Days of Sale
A review of 14 studies on restricting days of alcohol sale in both on-premise and off-premise settings showed strong evidence for the
effectiveness of maintaining limits on days of sale to reduce alcohol-related harms. The results indicate that increasing the days of sale led to increases in excessive drinking and associated harms such as motor vehicle crashes, impaired driving, assaults, domestic disturbances and intoxication requiring police intervention, while reducing the number of days generally
decreased harms (Middleton et al., 2010).
Privatization and Re-Monopolization
A systematic review of the effects of
privatization, which included 17 studies, found strong evidence that privatization leads to increases in excessive alcohol consumption (Hahn et al., 2012). Consequences of
privatization which inuence consumption noted among the studies include: increased number of alcohol outlets, increased hours and days of sale, advertising, greater brand selection, and acceptance of alternate forms of payment (e.g., credit card). Reviewers found that across the studies, privatization was associated with increases in per capita consumption of privatized alcoholic beverages without substantial reductions in consumption of the alcoholic beverages that were not sold through a privatized system. The researchers presented two studies that looked at privatization and motor vehicle crashes, but did not offer an overall conclusion about whether privatization increased vehicle incidents. One study,
examining the effects of re-monopolization, (government control of alcohol sale for a
previously-privatized system) found subsequent, although non-signicant decreases in alcohol- related harms (e.g., hospitalization for alcohol intoxication, alcohol psychosis, hospital
treatment for alcoholism). No ndings regarding whether re-monopolization reduced excessive consumption were offered (Hahn et al., 2012).
Limiting Alcohol Outlet Density
Alcohol outlet density is usually measured as the number of alcohol outlets per geographic area
or per population. Campbell et al. relied on both primary and secondary scientic evidence to assess the impact of changes in alcohol outlet density (2009). The primary evidence included studies that compared alcohol-related outcomes before and after a density change. The
secondary evidence included cross-sectional studies, which did not allow for the inference of causality.
The primary evidence research of 38 studies showed that as outlet density increased, consumption and related harms increased. A review of 74 cross-sectional studies showed a consistent and positive association between alcohol outlet density and excessive alcohol consumption and related harms, with the possible exception of injuries, for which the ndings were less consistent. The largest effect sizes were seen between outlet density and violent crime (Campbell et al., 2009).
In general, the literature search found reviews on restricting hours and days of sale, privatization and limiting outlet density, but it is important to note that more than just these factors inuence the physical availability of alcohol. Nonetheless, the ndings do focus attention on some
important and effective areas for action. Babor et al. noted that among the alcohol availability studies that have shown methods to reduce alcohol-related problems, the best evidence comes from studies on changes to retail availability, including reductions of hours and days of sale, outlet density limits and restrictions on retail access to alcohol (Babor et al., 2010). Within the grey literature of provincial, national and international reports and action plans on alcohol or related subjects, the need to restrict alcohol availability is consistently advised as an effective intervention to control and reduce excessive alcohol consumption and associated harms (British Columbia Ofce of the Provincial Health Ofcer, 2008; CPHA, 2011; Cancer Care Ontario & Ontario Agency for Health Protection and Promotion, 2012; Giesbrecht et al., 2013; Manafo & Giesbrecht, 2011; National Alcohol Strategy Working Group, 2007; WHO, 2011).
The Current Context
A provincial policy summary report revealed both strengths and gaps for Ontario in the following policy areas related to alcohol availability:
· Alcohol control system policy
· Physical availability policy
· Legal drinking age policy
· Server/retail challenge and refusal program policy
(Giesbrecht & Wettlaufer, 2013a).
Ontario's ranking shows that more can be done to improve the regulation of alcohol availability. Policies restricting alcohol availability are even more critical given the net economic loss due to the health and social costs from alcohol,
increasing per capita consumption, and political and commercial pressures favouring increased access. Fortunately, public support is strong for alcohol policy measures that restrict alcohol
availability (Figure 6.0, 6.1 and 6.2).
PHUs recognize “increasing alcohol access” as an issue affecting levels of alcohol harms (Figure 6.3). The public health unit survey results
indicate that PHUs are working to affect alcohol availability through policy, advocacy, awareness and education, community partnerships and municipal regulation.
Key informant interviews also provided multiple insights and ideas for action. The evidence- based action most often advised for the local government was to address the built
environment to reduce access to alcohol (e.g., through a review of alcohol outlet density or retail proximity to neighborhoods) (Figure 6.4).
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Addressing Alcohol Consumption and Alcohol-Related Harms at the Local Level
Figure 6.1: Corner stores: Percentage of Ontario adults ages 18+ responding whether or not alcohol should be available in corner stores, 2010 CAMH Monitor
Source: Centre for Addiction and Mental Health. (2011). CAMH population studies eBulletin. (Vol.12, No.3). Toronto, Ontario: Centre for Addiction and Mental Health. Reproduced with permission.
FIGURE 6.2: Privatization: Percentage of Ontario adults ages 18+ responding whether they agree or disagree that all LCBO stores should be privatized, 2010 CAMH Monitor
Source: Centre for Addiction and Mental Health. (2011). CAMH population studies eBulletin. (Vol.12, No.3). Toronto, Ontario: Centre for Addiction and Mental Health. Reproduced with permission. Figure 6.0: Store hours: Percentage of Ontario adults
ages 18+ responding whether beer and liquor store hours should be increased, decreased, or remain the same, 2010 CAMH Monitor
Source: Centre for Addiction and Mental Health. (2011).
CAMH population studies eBulletin. (Vol.12, No.3). Toronto, Ontario: Centre for Addiction and Mental Health. Reproduced with permission.
FIGURE 6.3 PHU Survey
# of references
Lack of resources 8
Technology - posi ve impact 10
Other 10
Lack of awareness around the harms of
alcohol 12
Lack of adver sing and marke ng
regula ons 13
Increasing alcohol access 14
Technology - nega ve impact 15
Culture of alcohol 15
Support at the provincial and local level 19
Demographics and geography 19
Compe ng priori es 20
Lack of support at the provincial and local
level 26
Response rate (29/32) 91%
What changing trends impact your work in addressing alcohol/reducing alcohol-related harms at the local level?
8 10 10 12 13 14 15 15 19 19 20 26 0 10 20 30 Lack of resources Technology - posi ve impact Other Lack of awareness around the harms of alcohol
Lack of adver sing and marke ng regula ons Increasing alcohol access Technology - nega ve impact Culture of alcohol Support at the provincial and local level
Demographics and geography Compe ng priori es Lack of support at the provincial and local level
# of references
Key informants shared knowledge about successful municipal-level actions or provided ideas to address alcohol availability:
“One of the ways we were able to make progress with tobacco was going after the second- hand smoke issue and its harm to others. There probably is greatest potential for that kind of argument with alcohol as well.”
Key Informant
“The best example I can think of from tobacco is the rst spot in Canada to implement bans on smoking in restaurants, in Waterloo Region. At the time, people thought it would never work. They implemented it, evaluated it, they proved it worked and now smoking bans are in restaurants everywhere.”
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Addressing Alcohol Consumption and Alcohol-Related Harms at the Local Level
# of references
Addressing treatment 3
Drinking and driving countermeasures 4
Advoca ng for provincial policy 5
Addressing alcohol marke ng 5
Suppor ng community partnerships 7
Suppor ng municipal policy 8
Suppor ng public health programming 8 Altering the built environment to reduce
alcohol access 9
# of interviewees ques on asked to 9
# of interviewees who provided a response 9
Response rate (9/9) 100%
What key evidence-based strategies should local governments implement to reduce alcohol-related harms?
Based on your experience with tobacco preven on, protec on and cessa on, what key evidence based strategies should local governments implement to reduce alcohol-related harms?
3 4 5 5 7 8 8 9 0 2 4 6 8 10 Addressing treatment Drinking and drinking countermeasures Advoca ng for provincial policy
Addressing alcohol marke ng Suppor ng community partnerships Suppor ng municipal policy Suppor ng public health programming Altering the built environment to
reduce alcohol access
# of references (version 1) (version 2)
FIGURE 6.4 KI Interview
I think the municipality should lead as much as they can on (availability) and seek to inuence the province when it comes to license applications. Municipalities can set up review bodies for any applications that come up for licenses, and seek to inuence the province in their decision. Certainly, municipalities can take direct control of special events, special event permits, on their own premises and can stipulate their own restrictions. They can also prohibit alcohol advertising that may inuence youth. They can restrict it or prohibit it from happening in their venues where youth may attend, such as hockey arenas. The boards of health can guide municipalities to do those things.”
Key Informant
“Boards of health can make
statements and pronouncements and issue reports about the harms that alcohol causes and the issue of access, especially by minors. I would think Boards of Health would want to restrict their consideration of issues in the alcohol area to things which municipal councils could embody in bylaws.”
Recommendations
Policy Area Recommendations Consider the following...
Physical Availability 3. Work with community stakeholders to continue to build support against the further expansion of alcohol sales. *16a, 19, 20, 27
4. Continue to inuence policy development around outlet density and hours of alcohol sale at the provincial and/or local level. *16c, 18, 27, 33
q Assess the potential threats of increasing availability of alcohol through:
Ÿ The potential privatization or semi-privatization of the LCBO
Ÿ Increase in privately-owned channels of alcohol access (e.g. farmers markets and convenience stores)
Ÿ Increase in retail outlets that offer alcohol at prices which do not meet minimum pricing (e.g., ferment-on-premise businesses)
q Participate in active public health surveillance of outlet density and associated harms
q Gather and present evidence on the need to set outlet density limits
q Assist municipalities to develop, implement and evaluate municipal alcohol policies and other strategies to address alcohol availability
*Refers to the alignment with specic recommendations within the National Alcohol Strategy Working Groups, Reducing Alcohol-Related Harm in Canada: Toward a Culture of Moderation – Recommendations for a National Alcohol Strategy (National Alcohol Strategy Working Group, 2007). Please note that this has been provided as a suggestion and others may nd that the recommendations align differently.
Implications
The decisions about regulating hours and days of sale, alcohol outlet density and maintaining government control of alcohol sales rests mainly at the provincial level. Nonetheless, local action to impact alcohol access is possible and
important because local and regional
governments do set some local regulations and policies related to alcohol availability.
Community and commercial groups can inuence these decisions. If PHUs want to
address alcohol-related policies, they must know
who the stakeholders are so that they can
anticipate and understand opposing viewpoints, recognize potential partners, and identify
decision makers. Appendix Q offers some possible stakeholders.
Several key informants recommended developing a local alcohol status report to engage stakeholders. They also recommended highlighting youth drinking and youth access to alcohol as well as the second-hand effects of alcohol as themes to draw interest and support from the community.
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Addressing Alcohol Consumption and Alcohol-Related Harms at the Local Level
Policy Area Examples of local public health action within the SEM
Physical Availability
Individual Interpersonal Organizational Community Public Policy
Increase public awareness about the impact of increased alcohol availability on the health and wellbeing of a community. Educate municipal staff and other stakeholders about strategies to limit the physical availability of alcohol. Build community support around the restriction of alcohol availability though active public health surveillance of outlet density and associated harms. Work with municipalities to implement zoning and licensing strategies to limit outlet density and hours of sale. Assist municipalities to create and evaluate municipal alcohol policies. Present evidence to policy-makers regarding the need to set outlet density limits through provincial legislation. Align with community stakeholders to build support against the further privatization of alcohol sales. Work with licensed establishments and other community stakeholders to improve the implementation and enforcement of server/retail training and challenge and refusal programs.
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Addressing Alcohol Consumption and Alcohol-Related Harms at the Local Level